<!DOCTYPE html>
<html lang="en">

<head>
    <!-- #include file="../com/link.asp" -->
   <style>
       .formProd{
           background: #fff;
           padding: 40px 20px;
       }
       .formProd .layui-input-block{
           width: 500px;
           float: left;
           margin-left: 10px;
       }
       .formProd .layui-input-block-btn{
          margin-left: 150px;
       }
       .formProd select{
           width: 500px;
       }
       .formProd p{
           line-height: 38px;
           font-size: 16px;
           color: #f08400;
       }
       .formProd h5{
           line-height: 38px;
           font-size: 16px;
       }
       .formProd .layui-form-label{
           width: 140px;
       }
   </style>
</head>

<body class="backCol">
    <!-- #include file="./header.asp" -->
    <div style="width: 1104px;" class="m1400">
        <div class="conTitle">申请开票</div>
        <form class="layui-form formProd" action="">
            <div class="layui-form-item">
                <label class="layui-form-label">开票项目：</label>
                <div class="layui-input-block">
                  <h5>信息服务技术费</h5>
                </div>
              </div>
              <div class="layui-form-item">
                <label class="layui-form-label">开票类型：</label>
                <div  class="layui-input-block">
                    <select name="city" lay-verify="">
                        <option value="">增值税专用发票</option>
                        <option value="010">北京</option>
                        <option value="021">上海</option>
                        <option value="0571">杭州</option>
                      </select>  
                </div>
              </div>
              <div class="layui-form-item">
                <label class="layui-form-label">开票金额：</label>
                <div class="layui-input-block">
                   <p>100元</p>
                </div>
              </div>
              <div class="layui-form-item">
                <label class="layui-form-label">单位名称：</label>
                <div class="layui-input-block">
                  <input type="text" name="title" required  lay-verify="required" autocomplete="off" class="layui-input">
                </div>
              </div>
              <div class="layui-form-item">
                <label class="layui-form-label">开户银行：</label>
                <div class="layui-input-block">
                  <input type="text" name="title" required  lay-verify="required" autocomplete="off" class="layui-input">
                </div>
              </div>
              <div class="layui-form-item">
                <label class="layui-form-label">银行账号：</label>
                <div class="layui-input-block">
                  <input type="text" name="title" required  lay-verify="required" autocomplete="off" class="layui-input">
                </div>
              </div>
              <div class="layui-form-item">
                <label class="layui-form-label">注册地址：</label>
                <div class="layui-input-block">
                  <input type="text" name="title" required  lay-verify="required" autocomplete="off" class="layui-input">
                </div>
              </div>
              <div class="layui-form-item">
                <label class="layui-form-label">注册电话：</label>
                <div class="layui-input-block">
                  <input type="text" name="title" required  lay-verify="required" autocomplete="off" class="layui-input">
                </div>
              </div>
              <div class="layui-form-item">
                <label class="layui-form-label">纳税人识别号：</label>
                <div class="layui-input-block">
                  <input type="text" name="title" required  lay-verify="required" autocomplete="off" class="layui-input">
                </div>
              </div>
              <div class="layui-form-item">
                <label class="layui-form-label">开票邮箱：</label>
                <div class="layui-input-block">
                  <input type="text" name="title" required  lay-verify="required" autocomplete="off" class="layui-input">
                </div>
              </div>
            <div class="layui-form-item">
              <div class="layui-input-block layui-input-block-btn">
                <button class="layui-btn" lay-submit lay-filter="formDemo">确认</button>
              </div>
            </div>
          </form>
    </div>
</body>

</html>